Provider Demographics
NPI:1598768160
Name:ELDER, KEVIN E (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:E
Last Name:ELDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:711 S DALE MABRY HWY STE 303
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4400
Mailing Address - Country:US
Mailing Address - Phone:813-635-2107
Mailing Address - Fax:813-605-6157
Practice Address - Street 1:711 S DALE MABRY HWY STE 303
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4400
Practice Address - Country:US
Practice Address - Phone:813-635-2107
Practice Address - Fax:813-605-6157
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81446207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266540900Medicaid
FL58043ZMedicare PIN
FLH30465Medicare UPIN